Towards Harmonisation of Critical Laboratory Result Management - Review of the Literature and Survey of Australasian Practices

Timely release and communication of critical test results may have significant impact on medical decisions and subsequent patient outcomes. Laboratories therefore have an important responsibility and contribution to patient safety. Certification, accreditation and regulatory bodies also require that laboratories follow procedures to ensure patient safety, but there is limited guidance on best practices. In Australasia, no specific requirements exist in this area and critical result reporting practices have been demonstrated to be heterogeneous worldwide.Recognising the need for agreed standards and critical limits, the AACB started a quality initiative to harmonise critical result management throughout Australasia. The first step toward harmonisation is to understand current laboratory practices. Fifty eight Australasian laboratories responded to a survey and 36 laboratories shared their critical limits. Findings from this survey are compared to international practices reviewed in various surveys conducted elsewhere. For the successful operation of a critical result management system, critical tests and critical limits must be defined in collaboration with clinicians. Reporting procedures must include how critical results are identified; who can report and who can receive critical results; what is an acceptable timeframe within which results must be delivered or, if reporting fails, what escalation procedures should follow; what communication channels or systems should be used; what should be recorded and how; and how critical result procedures should be maintained and evaluated to assess impact on outcomes.In this paper we review the literature of current standards and recommendations for critical result management. Key elements of critical result reporting are discussed in view of the findings of various national surveys on existing laboratory practices, including data from our own survey in Australasia. Best practice recommendations are made that laboratories are expected to follow in order to provide high quality and safe service to patients.     

Dendroclimatological investigation of mainland Australia's only alpine conifer,Podocarpus lawrencei Hook.f

Developing an understanding of the impact of climate on Australia's alpine flora is critical in anticipating the impacts of climate change. The dendroclimatological analysis of the Australian mainland's only alpine conifer, Podocarpus lawrencei Hook.f., may have particular significance in this regard. Unfortunately, eccentric tree-ring widths and frequent ring wedging have previously prevented dendroclimatic investigation of the species using core samples. In this study, we overcome this limitation by using full stem cross-sections collected from individuals killed during wildfire in 2003. Despite this advantage, ring wedging and poor circuit uniformity meant that crossdating was successful for portions or complete sections of only 56% of samples. Nevertheless, we constructed a crossdated chronology spanning 114-years (1888–2001) – the first for P. lawrencei. Climatological analysis revealed significant positive correlations with air temperature during spring of the growing season and significant negative correlations with monthly and seasonal snow variables as well as spring precipitation. Further analyses using 50-year moving windows reveal that responses to minimum air temperature and precipitation are unstable and periodically non-significant. Nevertheless, whilst correlation with mean maximum temperature during October and November (spring) of the growing season as well as the seasonal integration of snow cover exhibits variability throughout the analysis period, this variability appears to be independent of trends in both mean temperature and snow cover. We conclude, given the species longevity, its sensitivity to climate as well as the availability of sample material throughout the Australian Alps, that P. lawrencei holds a hitherto unrealised potential for climate reconstruction in south-east Australia. Further dendrochronological investigation of the species is currently underway throughout the Australian Alps to exploit this potential.     

Invasive African big-headed ants, Pheidole megacephala, on coral cays of the southern Great Barrier Reef: distribution and impacts on other ants

Infestation of islands by exotic ants is widespread and increasing due to human activities throughout the world. Exotic ants, particularly the invasive African big-headed ant, Pheidole megacephala (Fabricius), are of great conservation concern for coral cays at the southern end of the Great Barrier Reef, Australia. Little is known, however, about the distribution and ecological impacts of invasive ants in this insular system. We surveyed the ants of 14 vegetated coral cays recording a total of 24 ant species, including at least nine exotics. Pheidole megacephala was by far the most abundant and widespread species, occurring on 11 of 14 islands, often in very large numbers. The inter-island distribution of P. megacephala was best explained by human activities, with frequently visited, and to a lesser degree disturbed islands, more likely to be infested. On large islands (≥?10?ha) P. megacephala exhibited distinct habitat preferences, occurring in significantly lower abundances within heavily-shaded Pisonia grandis forest in the centre of islands, compared to more open, fringing woodland or shrubland. On smaller islands (<10?ha) with less extensive Pisonia stands, P. megacephala penetrated throughout the forest where its abundance was similar to that in open woodland. Despite considerable differences in biotic (floristic composition) and abiotic factors (e.g. island size) as well as the spatial configuration among islands, the severity of infestation by P. megacephala best explained variation in species richness, abundance and assemblage composition of other ants. We suggest a number of strategies to manage P. megacephala infestations on these islands.     

Establishment of native grassland vegetation at Organ Pipes National Park near Melbourne, Victoria: Vegetation changes from 1989 to 2003

Summary Native grassland establishment works undertaken on former agricultural land at Organ Pipes National Park, Victoria, during the 1980s were monitored from 1989 to 2003 to assess whether re‐introduced native plant populations had established and persisted at the site. Trends in vegetation were determined by examining the composition and cover of native and weed species in permanent transects at 2‐year intervals. The average number of native and weed species in plots changed little over 15 years, although weed species richness exhibited great variability. Of the 85 native species introduced to the grassland by seed, sods and tubestock, 33 were still present in 2003. The dominant native species, Kangaroo Grass (Themeda triandra), the native intertussock spear grasses (Austrostipa spp.), and the nationally endangered Large‐headed Groundsel (Senecio macrocarpus), have become common elements of the grassland but most other native species remain minor components. The cover of native and weed species has fluctuated dramatically over the study period in response to fire and drought. While the site remains largely weedy, the project has served to introduce native species into a secure reserve. It is clear that on‐going management (weed control, fire) and supplemental plantings will be necessary to maintain and expand the native species populations in the re‐established grassland.     

Restoration rocks: integrating abiotic and biotic habitat restoration to conserve threatened species and reduce fire fuel load

With rapid urban expansion, biodiversity conservation and human asset protection often require different regimes for managing wildfire risk. We conducted a controlled, replicated experiment to optimise habitat restoration for the threatened Australian pink-tailed worm-lizard, Aprasia parapulchella while reducing fire fuel load in a rapidly developing urban area. We used dense addition of natural rock (30 % cover) and native grass revegetation (Themeda triandra and Poa sieberiana) to restore critical habitat elements. Combinations of fire and herbicide (Glyphosate) were used to reduce fuel load and invasive exotic species. Rock restoration combined with herbicide application met the widest range of restoration goals: it reduced fire fuel load, increased ant occurrence (the primary prey of A. parapulchella) in the short-term and increased the growth and survival of native grasses. Lizards colonised the restored habitat within a year of treatment. Our study documents an innovative way by which conflicts between biodiversity conservation and human asset protection can be overcome.     

Becoming Sinless: Converting to Islam in the Christian Solomon Islands

ABSTRACT   Islam is beginning to have a significant presence in the predominantly Christian nation of Solomon Islands. A few well-educated Islanders were drawn to Islam's elegant monotheism and promise of unity in the 1980s and early 1990s, but numbers have grown significantly in the years following a violent civil conflict (1998–2003). Many of these new Muslim converts, especially those from the island of Malaita, seem preoccupied with the problem of sin and blame Christianity for destroying customary rules, especially those enforcing gender segregation. Echoing long-standing Malaitan critiques of Christian freedom, they say that Christians rely too heavily on God's grace and their own ability to resist temptation. Unlike Christianity and similar to the traditional religion of the islands, Islam provides clear moral rules for living. Seeking an escape from a cycle of sin and redemption, these ex-evangelical Christians now see in Islam the possibility of becoming sinless.